The death toll in Pakistan’s scorching heat wave, at least 838 deaths as of Wednesday afternoon, continues to rise.

At its epicenter is Karachi, home to 20 million people and the capital of the southern Sindh province. With temperatures reaching 113 degrees, hours-long power outages and insufficient running water contributed to make this heat wave the worst in a decade, the Associated Press reports.

The army has set up special heatstroke centers to help local officials deal with the situation, Maj. Gen. Asghar Nawaz, chairman of the National Disaster Management Authority, said. But hospitals have struggled to help victims, as most of them were the elderly, women and children. “Unfortunately, many victims were already unconscious when they were brought to our hospital in the past three or four days,” said Seemi Jamali, a spokeswoman for Karachi’s main Jinnah Hospital. “It was difficult to help them.”